Anesthesia providers play a pivotal role in perioperative infection control and maintaining sterility during procedures. As they frequently interact with sterile and non-sterile environments, adherence to strict aseptic techniques is essential. Failure to maintain sterility can lead to surgical site infections, bloodstream infections, and other nosocomial complications.
Aseptic technique involves practices that minimize the risk of microbial contamination. Hand hygiene is one of the most critical components, with the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) emphasizing the importance of proper handwashing before and after patient contact 1,2. Personal protective equipment, including sterile gloves, masks, gowns, and eye protection, serves as a barrier against pathogens. To maintain a sterile field, anesthesia providers should avoid breaches such as touching non-sterile surfaces or introducing non-sterile objects. Proper equipment handling, including the use of sterile drapes, single-use syringes, and thoroughly disinfected anesthesia workstations, further ensures sterility 3.
Anesthesia providers frequently handle multiple pieces of equipment and interact with various surfaces, making them potential vectors for contamination and complicating the process of maintaining sterility. The anesthesia workstation and associated equipment, including breathing circuits, laryngoscopes, and intravenous tubing, require proper handling and disinfection to prevent cross-contamination. Medication preparation and administration present additional risks, particularly when using multi-dose vials, intravenous ports, and syringes without proper aseptic techniques. Patient skin and mucosa serve as another source of microbial contamination, requiring thorough site preparation with antiseptics. Frequent contact with non-sterile areas, such as keyboards, monitors, and intravenous pumps, increases the risk of cross-contamination 4–7.
Maintaining sterility as an anesthesia provider requires strict adherence to best practices. Hand hygiene compliance is fundamental, with proper handwashing before putting on and after removing gloves. In addition, correct gloving techniques, including changing gloves if contamination occurs, can also help to reduce infection risks. Aseptic drug preparation involves using single-dose vials when feasible, disinfecting vial tops before access, and avoiding drawing up medications too far in advance. Equipment disinfection should also be routinely performed on high-touch surfaces within the anesthesia workspace. Sterile barrier use, including sterile drapes and protective covers, is a requirement for procedures such as central line placements and regional anesthesia blocks. Minimizing circuit manipulation by limiting disconnections of the anesthesia breathing circuit helps prevent bacterial transmission. Maintaining environmental awareness, including avoiding unnecessary movement near sterile fields, can also further help to reduce contamination risks 8–11.
These sterility practices are essential for preventing infections and ensuring optimal patient outcomes. Adhering to aseptic principles, recognizing contamination sources, and implementing best practices contribute to a safer perioperative environment. Continued education and adherence to infection control protocols are crucial in reducing the risk of healthcare-associated infections.
References
1. Hand hygiene. https://www.who.int/teams/integrated-health-services/infection-prevention-control/hand-hygiene.
2. CDC. About Hand Hygiene for Patients in Healthcare Settings. Clean Hands https://www.cdc.gov/clean-hands/about/hand-hygiene-for-healthcare.html (2024).
3. Ernstmeyer, K. & Christman, E. Chapter 4 Aseptic Technique. in Nursing Skills [Internet] (Chippewa Valley Technical College, 2021).
4. Baillie, J. K., Sultan, P., Graveling, E., Forrest, C. & Lafong, C. Contamination of anaesthetic machines with pathogenic organisms. Anaesthesia 62, 1257–1261 (2007). DOI: 10.1111/j.1365-2044.2007.05261.x
5. Macedo, C. E. et al. Contamination of equipment and surfaces in the operating room anesthesia workspace: a cross-sectional study. Sao Paulo Med J 142, e2023177. DOI: 10.1590/1516-3180.2023.0177.R1.291123
6. Loftus, R. W. et al. Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission. Anesth Analg 112, 98–105 (2011). DOI: 10.1213/ANE.0b013e3181e7ce18
7. Arai, L. A. de C. & Azevedo, R. B. Contamination of Anesthesia Circuits by Pathogens. Brazilian Journal of Anesthesiology 61, 50–59 (2011). DOI: 10.1016/S0034-7094(11)70006-X
8. Juwarkar, C. S. Cleaning and Sterilisation of Anaesthetic Equipment. Indian J Anaesth 57, 541–550 (2013). DOI: 10.4103/0019-5049.120152
9. Sabir, N. & Ramachandra, V. Decontamination of anaesthetic equipment. Continuing Education in Anaesthesia Critical Care & Pain 4, 103–106 (2004). DOI:
10.1093/bjaceaccp/mkh029
10. Association of Anaesthetists of Great Britain and Ireland. Infection Control in Anaesthesia. Anaesthesia 63, 1027–1036 (2008). DOI: 10.1111/j.1365-2044.2008.05657.x
11. Best Practices in Maintaining the Sterile Field. Infection Control Today https://www.infectioncontroltoday.com/view/best-practices-maintaining-sterile-field (2006).